Semelka R C, Kelekis N L, Molina P L, Sharp T J, Calvo B
Department of Radiology, University of North Carolina at Chapel Hill 27599-7510, USA.
J Magn Reson Imaging. 1996 Jul-Aug;6(4):585-8. doi: 10.1002/jmri.1880060405.
This prospective study evaluates the ability of MRI using T1-weighted fat-suppressed spin-echo (T1FS) and dynamic gadolinium chelate (Gd) enhanced spoiled-gradient echo (SGE) to detect the presence of pancreatic tumor in patients in whom spiral CT findings are inconclusive. Sixteen consecutive patients who underwent spiral CT and had findings that were considered inconclusive for pancreatic tumor underwent MR within 2 weeks of CT. Spiral CT and MR images were interpreted in prospective fashion by separate individual investigators blinded to the results of the other imaging modality. CT was performed on a spiral CT scanner. MRI was performed on on a 1.5-T MR machine. Imaging sequences included T1FS pre-Gd and post-Gd and SGE pre-Gd and immediately post-Gd. Data were analyzed using receiver operating characteristic (ROC) analysis. Confirmation was obtained by pancreatic biopsy (n = 4), surgical resection (n = 1), and clinical imaging (n = 4) or clinical follow-up (n = 7). MRI was superior to spiral CT (P = .027) in this selected patient group at detecting or excluding pancreatic tumor by ROC analysis, with areas under the curve of .982 and .764, respectively, which was significant (P = .041). The greatest advantage of MRI was in patients in whom spiral CT demonstrated enlargement of the pancreatic head without clear definition of tumor, which was significant (P = .033). In 10 patients with this CT appearance, MRI demonstrated a high confidence for presence of tumor in four and a high confidence of absence in six. Association of imaging findings with patient diagnosis was significant for MRI (P = .001) but not significant for CT (P = .148). The results of our study suggest that MRI may add significant diagnostic information in patients in whom spiral CT is inconclusive for the presence of pancreatic tumor. The greatest advantage of MRI was in the evaluation of patients in whom spiral CT findings revealed an indeterminate enlarged pancreatic head.
这项前瞻性研究评估了使用T1加权脂肪抑制自旋回波（T1FS）和动态钆螯合物（Gd）增强扰相梯度回波（SGE）的MRI检测螺旋CT检查结果不明确的患者胰腺肿瘤的能力。16例连续接受螺旋CT检查且胰腺肿瘤检查结果不明确的患者在CT检查后2周内接受了MR检查。螺旋CT和MR图像由对另一种成像方式结果不知情的独立个体研究者以前瞻性方式进行解读。CT在螺旋CT扫描仪上进行。MRI在1.5-T MR机器上进行。成像序列包括Gd注射前和注射后的T1FS以及Gd注射前和注射后即刻的SGE。使用受试者操作特征（ROC）分析对数据进行分析。通过胰腺活检（n = 4）、手术切除（n = 1）、临床影像学检查（n = 4）或临床随访（n = 7）获得确诊。通过ROC分析，在这个选定的患者组中，MRI在检测或排除胰腺肿瘤方面优于螺旋CT（P = .027），曲线下面积分别为.982和.764，具有显著性差异（P = .041）。MRI的最大优势在于螺旋CT显示胰头增大但肿瘤未明确界定的患者，差异具有显著性（P = .033）。在10例有这种CT表现的患者中，MRI对4例患者高度怀疑存在肿瘤，对6例患者高度怀疑不存在肿瘤。MRI的影像学表现与患者诊断之间的关联具有显著性（P = .001），而CT则无显著性（P = .148）。我们的研究结果表明，对于螺旋CT对胰腺肿瘤存在与否检查结果不明确的患者，MRI可能会提供重要的诊断信息。MRI的最大优势在于评估螺旋CT检查结果显示胰头增大但性质不确定的患者。
